¹Ruhr-Universitätsklinikum JWK Minden, Klinik für Rheumatologie und klinische Immunologie, Minden
²Universitätsklinikum des Saarlandes, Jose Carreras Institut für Gen- und Immuntherapie, Homburg
³Ruhr-Universitätsklinikum JWK Minden, Institut für Radiologie, Minden
⁴Fachklinik Sendenhorst, Klinik für Rheumaorthopädie, Sendenhorst
⁵Ruhr-Universitätsklinikum JWK Minden, Klinik für Orthopädie und Unfallchirurgie, Minden

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Introduction: In patients with adult CNO and SAPHO syndrome, the manifestations of osteitis with hyperostosis are very common in the area of the sternocostoclavicular joints (SCCH). The manifestation often causes considerable discomfort and is difficult to influence therapeutically. The use of DMARDs shows a certain degree of success; in therapy-resistant and highly symptomatic cases, infiltrations of local anesthetics and/or glucocorticoids or radiotherapy are also used with limited success. Follow-up of 5 adult CNO patients with resection arthroplasty with synovectomy for SCCH.

Methods: Between 2018 and 2023, 5 patients with adult CNO in a refractory situation underwent resection arthroplasty with synovectomy for SCCH at Saarland University Hospital (n=2), Sendenhorst Hospital (n=2) and Minden University Hospital JWK (n=1). A clinical follow-up was carried out within three months before and one year after the operation to determine the osteitis score (0-6, assessed by physician), the Health assessment questionnaire HAQ (by patient), and an MRI to evaluate the activity. The synovium was histologically evaluated for synovitis according to the Krenn score [1].

Results: Patients’ characteristics and their outcome are shown in Table 1 [Tab. 1]. The CNO patients were between 51 and 61 years of age and suffered from SCCH for a mean of 69 months (54 to 84) without a significant therapeutic effect on at least 4 to a maximum of 8 non-surgery therapeutic strategies for disease control. Two patients had bilateral SCCH, but only the symptomatic side was operated on. The surgical procedure was without complications in all patients, all showed a significant clinical response measured after 1 year (osteitis score, HAQ), a follow-up MRI documented an improvement in the findings due to bone marrow edema as well as synovitis (Fiure 1 [Fig. 1]).

Conclusion: The case series documents a surprisingly positive longterm outcome for resection arthroplasty with synovectomy in cases of resistance to conservative treatment for SCCH in adult CNO.

Literatur

[1] Krenn V, Morawietz L, Burmester GR, Häupl T. Synovialitis-Score: Histopathologisches Graduierungsschema rheumatischer und nicht-rheumatischer Synovialitiden [Synovialitis score: histopathological grading system for chronic rheumatic and non-rheumatic synovialitis]. Z Rheumatol. 2005 Jun;64(5):334-42. German. DOI: 10.1007/s00393-005-0704-x